There's been a lot of speculation about what will happen to the Affordable Care Act (ACA)--commonly referred to as a Obamacare--if Mitt Romney is elected in November. Although Mr. Romney has repeatedly promised to repeal the ACA on day one of his presidency, the reality is that no President has the power overturn a law without Congressional support. Here's why the ACA is likely here to stay--and what physicians can do to prepare for the the act.

There Isn't Enough Congressional Support 
Because the ACA is an Act of Congress, it would require a majority support from both houses of Congress to overturn it. Under current electoral projections, however, Republicans will maintain control of the House of Representatives and Democrats will maintain control of the Senate. With a Senate controlled by the Democrats at 50-48, Romney will have difficulty garnering Congressional support to overturn the ACA.

While it's possible that a Romney win could help Republicans win more seats in the Senate and take back control from Democrats, history suggests it's unlikely. In the last century, the sitting President’s party has won seats in the Senate in 21 out of 26 midterm elections. Under this scenario, Republicans would lose even more Senate seats.

An Executive Order Can't Overturn a Law
Without Congressional support, the only other weapon that Romney has to overturn the ACA is an Executive Order. However, an Executive Order is not enough to undo an Act of Congress, and an attempt to do so would lead to a futile legal battle.

However, the ACA does give the president the power to grant states waivers for certain portions of the Act–but this capability is much more limiting than the Romney campaign suggests. First, the waiver provision doesn’t go into effect until January 1, 2017 (close to the last day of the next presidential term). Second, it requires each state to apply to the Secretary of Health and Human Services, rather than have an Executive Order initiate the process. Finally, it requires a state to demonstrate that it provides the same amount of individual and financial coverage as the waiver provides. This provision offers states some flexibility to develop their own health plans, but doesn’t actually exempt them from anything.

In short, Romney will not be able to dissolve the ACA. 

Five Ways Physicians Can Adapt to the ACA
In light of these considerations, physicians should be thinking about how they can adapt their practice to fit the new requirements of the ACA. Here are five areas that doctors can focus on. 
 
1. Prepare for More Patients. The extension of coverage under the ACA and the new requirement for insurance companies to cover individuals with pre-existing conditions will likely lead to an increase in the number of patients that practices have to see. To prepare for this influx, it might be a good idea to expand your staff or extend office hours. 
 
2. Decide if You'll Support Medicare and Medicaid. These days, Medicare and Medicaid only cover about 81 percent of private insurance reimbursements. Doctors will have to decide whether they will accept Medicare or Medicaid payments--or come up with creative ways to make up the cost difference. 
 
3. Decide Whether You Want Electronic Health Records (EHRs). The ACA expands reporting requirements for the Physician Quality Reporting System (PQRS) for Medicare reimbursements. Starting in 2015, there will be penalties on Medicare reimbursements for practices that have failed to adopt an EHR (read more here). This means that if practices decide to serve Medicare customers, they'll need to adopt an EHR. 
 
4. Consider Moving to Underserved Areas. The ACA offers some incentives for practices that locate in underserved (primarily rural) parts of the country. The service provides loan repayments and scholarships for doctors that practice in rural areas. While established doctors most likely won't want to move, this can be an attractive option for young doctors just getting their start. 
 
5. Evaluate Bundled Payments. There is going to be a shift from government payers separately reimbursing physicians, labs and hospitals to "bundling payments." This means that you'll have to collect payments directly from a mutual association rather than from Medicare directly. This may require you to change the way your bill for care. 

Of course, all of this is speculative. Large-scale initiatives like the ACA have a way of resulting in unintended consequences, and it’s impossible to forecast all the financial impacts it might have on medical practices. So, expect the unexpected–but do expect that the ACA will be there. 

What ways are you preparing for the ACA? Please leave your advice and thoughts in the comments section below.